FISDAP CARDIOLOGY FULL REVIEW (PARAMEDIC) EXPERT
VERIFIED 550+ ACTUAL QUESTIONS & ANSWERS WITH
RATIONALES FOR GUARANTEED PASS
You respond to a residence for a 68-year-old male with nausea, vomiting, and blurred vision.
As you are assessing him, he tells you that he has congestive heart failure and atrial
fibrillation, and takes numerous medications. The cardiac monitor reveals atrial fibrillation
with a ventricular rate of 50 beats/min. Which of the following medications is MOST likely
responsible for this patient's clinical presentation? -ANSWER-Digoxin.
This patient has classic signs of digitalis toxicity. Digoxin is commonly prescribed to patients
with congestive heart failure and atrial fibrillation (A-Fib) or atrial flutter (A-Flutter). Its
positive inotropic effects increase cardiac contractility and maintain cardiac output, while its
negative chronotropic effects control the ventricular rate of the A-Fib or A-Flutter. Digitalis
preparations (ie, Lanoxin, Digoxin) have a narrow therapeutic index—that is, there is a fine
line between a therapeutic and toxic dose. You should suspect digitalis toxicity in any patient
who takes Digoxin or Lanoxin and presents with complaints such as nausea, vomiting,
abdominal pain, anorexia, or blurred/yellow vision. Additionally, virtually any cardiac
dysrhythmia can be caused by the toxic effects of digitalis. Treatment involves the
administration of Digibind, which is given at the hospital.
Which of the following is an absolute contraindication for fibrinolytic therapy? -ANSWER-
Subdural hematoma 3 years ago.
According to current emergency cardiac care (ECC) guidelines, absolute contraindications for
fibrinolytic therapy include ANY prior intracranial hemorrhage (ie, subdural, epidural,
intracerebral hematoma); known structural cerebrovascular lesion (ie, arteriovenous
malformation); known malignant intracranial tumor (primary or metastatic); ischemic stroke
within the past 3 months, EXCEPT for acute ischemic stroke within the past 3 hours;
suspected aortic dissection; active bleeding or bleeding disorders (except menses); and
significant closed head trauma or facial trauma within the past 3 months. Relative
contraindications (eg, the physician may deem fibrinolytic therapy appropriate under certain
circumstances) include, a history of chronic, severe, poorly-controlled hypertension; severe
uncontrolled hypertension on presentation (SBP > 180 mm Hg or DBP > 110 mm Hg);
ischemic stroke greater than 3 months ago; dementia; traumatic or prolonged (> 10 minutes)
,CPR or major surgery within the past 3 weeks; recent (within 2 to 4 weeks) internal bleeding;
noncompressible vascular punctures; pregnancy; prior exposure (> 5 days ago) or prior
allergic reaction to streptokinase or anistreplase; active peptic ulcer; and current use of
anticoagulants (ie, Coumadin).
A middle-aged man presents with chest discomfort, shortness of breath, and nausea. You
give him supplemental oxygen and continue your assessment. As your partner is attaching
the ECG leads, you should: -ANSWER-Administer up to 325 mg of aspirin.
Since oxygen has already been administered to this patient and your partner is attaching the
ECG leads, you should administer aspirin (160 to 325 mg, non-enteric-coated). Early
administration of aspirin has clearly been shown to reduce mortality and morbidity in
patients experiencing an acute coronary syndrome (ACS). After establishing vascular access,
you should assess his vital signs and then administer 0.4 mg of nitroglycerin (up to 3 doses, 5
minutes apart), provided that his systolic BP is greater than 90 mm Hg. If 3 doses of
nitroglycerin fail to completely relieve his chest discomfort, consider administering 2 to 4 mg
of morphine IV, provided that his systolic BP remains above 90 mm Hg.
Which of the following ECG lead configurations is correct? -ANSWER-To assess lead II, place
the negative lead on the right arm and the positive lead on the left leg.
According to the Einthoven triangle, lead I is assessed by placing the negative (white) lead on
the right arm and the positive (red) lead on the left arm. Lead II is assessed by placing the
negative lead on the right arm and the positive lead on the left leg. Lead III is assessed by
placing the negative lead on the left arm and the positive lead on the left leg.
A 61-year-old male presents with chest pressure that woke him up from his nap 30 minutes
ago. He is diaphoretic, anxious, and rates his pain as an an 8 over 10. His past medical history
is significant for hypertension, type II diabetes, and coronary stent placement 2 months ago.
He takes lisinopril, Plavix, and Glucophage, and is wearing a medical alert bracelet stating
"allergic to salicylates." His blood pressure is 160/100 mm Hg, pulse is 110 beats/min, and
respirations are 22 breaths/min. The 12-lead ECG shows sinus tachycardia with 3-mm ST
segment elevation in leads V1 through V5. Which of the following treatment modalities is
MOST appropriate for this patient? -ANSWER-Supplemental oxygen, vascular access, up to
three 0.4 mg doses of nitroglycerin, and 2 to 4 mg of morphine sulfate if his systolic BP is
greater than 90 mm Hg and he is still experiencing pain.
,The patient is experiencing an acute coronary syndrome (ACS). His 12-lead ECG indicates
anteroseptal injury with lateral extension (ST elevation in leads V1 through V5). Appropriate
treatment includes oxygen (maintain an SpO2 of greater than 94%), vascular access, up to
three 0.4 mg doses of nitroglycerin (NTG), and 2 to 4 mg of morphine if NTG fails to relieve
his pain and his systolic BP is above 90 mm Hg. Some EMS systems may use fentanyl
(Sublimaze) for analgesia. Aspirin, a salicylate, is also given to patients with ACS; however,
this patient is allergic to salicylates. Obtain a right-sided 12-lead ECG in patients with signs of
inferior wall injury (ST elevation in leads II, III, aVF). Inferior wall infarctions may involve the
right ventricle; a right-sided 12-lead ECG will help confirm this. Apply the multi-pads to the
patient, not because he is at risk for bradycardia (more common with inferior infarctions),
but because he is at risk for cardiac arrest due to V-Fib or pulseless V-Tach.
You and your team are performing CPR on a 70-year-old male. The cardiac monitor reveals a
slow, organized rhythm. His wife tells you that he goes to dialysis every day, but has missed
his last three treatments. She also tells you that he has high blood pressure,
hyperthyroidism, and has had several cardiac bypass surgeries. Based on the patient's
medical history, which of the following conditions is the MOST likely underlying cause of his
condition? -ANSWER-Hyperkalemia.
Although any of the listed conditions could be causing this patient's condition, the fact that
he missed his last three dialysis treatments should make you most suspicious for
hyperkalemia. Dialysis filters metabolic waste products from the blood in patients with renal
insufficiency or failure. If the patient is not dialyzed, these waste products, including
potassium and other electrolytes, accumulate to toxic levels in the blood. In addition to
performing high-quality CPR, managing the airway, and administering epinephrine, your
protocols may call for the administration of calcium chloride and sodium bicarbonate if
hyperkalemia is suspected. Albuterol also has been shown to be effective in treating patients
with hyperkalemia becauses it causes potassium to shift back into the cells; it can be
nebulized down the ET tube or administered intravenously. Follow your local protocols
regarding the treatment for suspected hyperkalemia.
Which of the following represents the MOST appropriate initial drug and dose that is given
to all adult patients in cardiac arrest? -ANSWER-10 mL of epinephrine 1:10,000 every 3 to 5
minutes.
, Once vascular access has been obtained (IV or IO), the first drug and dose given to all
patients in cardiac arrest—regardless of the rhythm on the cardiac monitor—is epinephrine
1 mg (10 mL) of a 1:10,000 solution, repeated every 3 to 5 minutes. You may consider a one-
time dose of vasopressin (40 units) to replace the first or second dose of epinephrine, but
not both. Higher doses of epinephrine may be necessary if special circumstances exist (ie,
severe beta-blocker toxicity). Consult with medical control as needed.
The MOST appropriate initial action for a 54-year-old man who presents with the following
cardiac rhythm should consist of: -ANSWER-Assessing the patient's clinical status.
When assessing the cardiac rhythm of any patient, you must interpret it in the context of his
or her clinical status. Before you reach for atropine or a pacemaker, determine if the
bradycardia is causing hemodynamic compromise (ie, hypotension, altered mental status,
chest pressure or discomfort, pulmonary edema). If the patient is hemodynamically
unstable, treat according to established ACLS guidelines (ie, atropine, pacing, etc.). However,
if the patient is hemodynamically stable, simply monitor his or her clinical status and
transport to the hospital.
When assessing a patient's pulse, you note that it is fast and has an irregularly irregular
pattern. On the basis of these findings, which of the following cardiac rhythms would MOST
likely be seen on the cardiac monitor? -ANSWER-Uncontrolled atrial fibrillation.
Of the cardiac rhythms listed, atrial fibrillation (A-Fib) is the only one that is irregularly
irregular. In fact, A-Fib is never seen as a regular rhythm. At a rate of less than 100
beats/min, A-Fib is said to be controlled. Uncontrolled A-Fib, or A-Fib with a rapid ventricular
rate (RVR), occurs when the ventricular rate exceeds 100 beats/min. Second-degree AV block
type I has a pattern that is regularly irregular; the P-R interval progressively lengthens until a
P wave is blocked. Ventricular tachycardia (V-Tach) and supraventricular tachycardia (SVT)
are typically regular rhythms.
What is the correct initial dose and rate of administration of amiodarone for a patient with
refractory ventricular fibrillation? -ANSWER-300 mg via rapid IV or IO push.
The correct initial dose and rate of administration of amiodarone for a patient with
refractory ventricular fibrillation or pulseless ventricular tachycardia is 300 mg rapid IV or IO
VERIFIED 550+ ACTUAL QUESTIONS & ANSWERS WITH
RATIONALES FOR GUARANTEED PASS
You respond to a residence for a 68-year-old male with nausea, vomiting, and blurred vision.
As you are assessing him, he tells you that he has congestive heart failure and atrial
fibrillation, and takes numerous medications. The cardiac monitor reveals atrial fibrillation
with a ventricular rate of 50 beats/min. Which of the following medications is MOST likely
responsible for this patient's clinical presentation? -ANSWER-Digoxin.
This patient has classic signs of digitalis toxicity. Digoxin is commonly prescribed to patients
with congestive heart failure and atrial fibrillation (A-Fib) or atrial flutter (A-Flutter). Its
positive inotropic effects increase cardiac contractility and maintain cardiac output, while its
negative chronotropic effects control the ventricular rate of the A-Fib or A-Flutter. Digitalis
preparations (ie, Lanoxin, Digoxin) have a narrow therapeutic index—that is, there is a fine
line between a therapeutic and toxic dose. You should suspect digitalis toxicity in any patient
who takes Digoxin or Lanoxin and presents with complaints such as nausea, vomiting,
abdominal pain, anorexia, or blurred/yellow vision. Additionally, virtually any cardiac
dysrhythmia can be caused by the toxic effects of digitalis. Treatment involves the
administration of Digibind, which is given at the hospital.
Which of the following is an absolute contraindication for fibrinolytic therapy? -ANSWER-
Subdural hematoma 3 years ago.
According to current emergency cardiac care (ECC) guidelines, absolute contraindications for
fibrinolytic therapy include ANY prior intracranial hemorrhage (ie, subdural, epidural,
intracerebral hematoma); known structural cerebrovascular lesion (ie, arteriovenous
malformation); known malignant intracranial tumor (primary or metastatic); ischemic stroke
within the past 3 months, EXCEPT for acute ischemic stroke within the past 3 hours;
suspected aortic dissection; active bleeding or bleeding disorders (except menses); and
significant closed head trauma or facial trauma within the past 3 months. Relative
contraindications (eg, the physician may deem fibrinolytic therapy appropriate under certain
circumstances) include, a history of chronic, severe, poorly-controlled hypertension; severe
uncontrolled hypertension on presentation (SBP > 180 mm Hg or DBP > 110 mm Hg);
ischemic stroke greater than 3 months ago; dementia; traumatic or prolonged (> 10 minutes)
,CPR or major surgery within the past 3 weeks; recent (within 2 to 4 weeks) internal bleeding;
noncompressible vascular punctures; pregnancy; prior exposure (> 5 days ago) or prior
allergic reaction to streptokinase or anistreplase; active peptic ulcer; and current use of
anticoagulants (ie, Coumadin).
A middle-aged man presents with chest discomfort, shortness of breath, and nausea. You
give him supplemental oxygen and continue your assessment. As your partner is attaching
the ECG leads, you should: -ANSWER-Administer up to 325 mg of aspirin.
Since oxygen has already been administered to this patient and your partner is attaching the
ECG leads, you should administer aspirin (160 to 325 mg, non-enteric-coated). Early
administration of aspirin has clearly been shown to reduce mortality and morbidity in
patients experiencing an acute coronary syndrome (ACS). After establishing vascular access,
you should assess his vital signs and then administer 0.4 mg of nitroglycerin (up to 3 doses, 5
minutes apart), provided that his systolic BP is greater than 90 mm Hg. If 3 doses of
nitroglycerin fail to completely relieve his chest discomfort, consider administering 2 to 4 mg
of morphine IV, provided that his systolic BP remains above 90 mm Hg.
Which of the following ECG lead configurations is correct? -ANSWER-To assess lead II, place
the negative lead on the right arm and the positive lead on the left leg.
According to the Einthoven triangle, lead I is assessed by placing the negative (white) lead on
the right arm and the positive (red) lead on the left arm. Lead II is assessed by placing the
negative lead on the right arm and the positive lead on the left leg. Lead III is assessed by
placing the negative lead on the left arm and the positive lead on the left leg.
A 61-year-old male presents with chest pressure that woke him up from his nap 30 minutes
ago. He is diaphoretic, anxious, and rates his pain as an an 8 over 10. His past medical history
is significant for hypertension, type II diabetes, and coronary stent placement 2 months ago.
He takes lisinopril, Plavix, and Glucophage, and is wearing a medical alert bracelet stating
"allergic to salicylates." His blood pressure is 160/100 mm Hg, pulse is 110 beats/min, and
respirations are 22 breaths/min. The 12-lead ECG shows sinus tachycardia with 3-mm ST
segment elevation in leads V1 through V5. Which of the following treatment modalities is
MOST appropriate for this patient? -ANSWER-Supplemental oxygen, vascular access, up to
three 0.4 mg doses of nitroglycerin, and 2 to 4 mg of morphine sulfate if his systolic BP is
greater than 90 mm Hg and he is still experiencing pain.
,The patient is experiencing an acute coronary syndrome (ACS). His 12-lead ECG indicates
anteroseptal injury with lateral extension (ST elevation in leads V1 through V5). Appropriate
treatment includes oxygen (maintain an SpO2 of greater than 94%), vascular access, up to
three 0.4 mg doses of nitroglycerin (NTG), and 2 to 4 mg of morphine if NTG fails to relieve
his pain and his systolic BP is above 90 mm Hg. Some EMS systems may use fentanyl
(Sublimaze) for analgesia. Aspirin, a salicylate, is also given to patients with ACS; however,
this patient is allergic to salicylates. Obtain a right-sided 12-lead ECG in patients with signs of
inferior wall injury (ST elevation in leads II, III, aVF). Inferior wall infarctions may involve the
right ventricle; a right-sided 12-lead ECG will help confirm this. Apply the multi-pads to the
patient, not because he is at risk for bradycardia (more common with inferior infarctions),
but because he is at risk for cardiac arrest due to V-Fib or pulseless V-Tach.
You and your team are performing CPR on a 70-year-old male. The cardiac monitor reveals a
slow, organized rhythm. His wife tells you that he goes to dialysis every day, but has missed
his last three treatments. She also tells you that he has high blood pressure,
hyperthyroidism, and has had several cardiac bypass surgeries. Based on the patient's
medical history, which of the following conditions is the MOST likely underlying cause of his
condition? -ANSWER-Hyperkalemia.
Although any of the listed conditions could be causing this patient's condition, the fact that
he missed his last three dialysis treatments should make you most suspicious for
hyperkalemia. Dialysis filters metabolic waste products from the blood in patients with renal
insufficiency or failure. If the patient is not dialyzed, these waste products, including
potassium and other electrolytes, accumulate to toxic levels in the blood. In addition to
performing high-quality CPR, managing the airway, and administering epinephrine, your
protocols may call for the administration of calcium chloride and sodium bicarbonate if
hyperkalemia is suspected. Albuterol also has been shown to be effective in treating patients
with hyperkalemia becauses it causes potassium to shift back into the cells; it can be
nebulized down the ET tube or administered intravenously. Follow your local protocols
regarding the treatment for suspected hyperkalemia.
Which of the following represents the MOST appropriate initial drug and dose that is given
to all adult patients in cardiac arrest? -ANSWER-10 mL of epinephrine 1:10,000 every 3 to 5
minutes.
, Once vascular access has been obtained (IV or IO), the first drug and dose given to all
patients in cardiac arrest—regardless of the rhythm on the cardiac monitor—is epinephrine
1 mg (10 mL) of a 1:10,000 solution, repeated every 3 to 5 minutes. You may consider a one-
time dose of vasopressin (40 units) to replace the first or second dose of epinephrine, but
not both. Higher doses of epinephrine may be necessary if special circumstances exist (ie,
severe beta-blocker toxicity). Consult with medical control as needed.
The MOST appropriate initial action for a 54-year-old man who presents with the following
cardiac rhythm should consist of: -ANSWER-Assessing the patient's clinical status.
When assessing the cardiac rhythm of any patient, you must interpret it in the context of his
or her clinical status. Before you reach for atropine or a pacemaker, determine if the
bradycardia is causing hemodynamic compromise (ie, hypotension, altered mental status,
chest pressure or discomfort, pulmonary edema). If the patient is hemodynamically
unstable, treat according to established ACLS guidelines (ie, atropine, pacing, etc.). However,
if the patient is hemodynamically stable, simply monitor his or her clinical status and
transport to the hospital.
When assessing a patient's pulse, you note that it is fast and has an irregularly irregular
pattern. On the basis of these findings, which of the following cardiac rhythms would MOST
likely be seen on the cardiac monitor? -ANSWER-Uncontrolled atrial fibrillation.
Of the cardiac rhythms listed, atrial fibrillation (A-Fib) is the only one that is irregularly
irregular. In fact, A-Fib is never seen as a regular rhythm. At a rate of less than 100
beats/min, A-Fib is said to be controlled. Uncontrolled A-Fib, or A-Fib with a rapid ventricular
rate (RVR), occurs when the ventricular rate exceeds 100 beats/min. Second-degree AV block
type I has a pattern that is regularly irregular; the P-R interval progressively lengthens until a
P wave is blocked. Ventricular tachycardia (V-Tach) and supraventricular tachycardia (SVT)
are typically regular rhythms.
What is the correct initial dose and rate of administration of amiodarone for a patient with
refractory ventricular fibrillation? -ANSWER-300 mg via rapid IV or IO push.
The correct initial dose and rate of administration of amiodarone for a patient with
refractory ventricular fibrillation or pulseless ventricular tachycardia is 300 mg rapid IV or IO
